The opioid epidemic and HCV STACEY B. TROOSKIN MD PHD DIRECTOR OF - - PowerPoint PPT Presentation

The opioid epidemic and HCV

STACEY B. TROOSKIN MD PHD DIRECTOR OF VIRAL HEPATITIS PROGRAMS PHILADELPHIA FIGHT COMMUNITY HEALTH CENTERS PHILADELPHIA, PA

Philadelphia FIGHT

The Jonathan Lax Treatment Center The Youth Health Empowerment Project The John Bell Health Center COMMUNITY BASED TESTING Syringe Exchange Program Drug Treatment Programs Homeless shelters Opioid substitution programs Senior Centers

A typical day in HCV clinic

24 yr old male Tested for HCV at syringe exchange program (SEP) Brought into clinic by HCV patient navigator On suboxone, 2 months off heroin Would like to be treated for HCV

His story

Started experimenting with drugs at the age of 15 Prescription drugs (“percs”, “oxys”, “xanies”) Stated snorting heroin at age 19, injected age 21 Homeless at 22 Good health otherwise except for dental issues and depression

200 400 600 800 1000

1 3 5 7 9 11131517192123252729313335373941434547495153555759616365676971737577798183858789919395

2003 200 400 600 800 1000

1 3 5 7 9 11131517192123252729313335373941434547495153555759616365676971737577798183858789919395

2005 200 400 600 800 1000

1 3 5 7 9 11131517192123252729313335373941434547495153555759616365676971737577798183858789919395

2007 200 400 600 800 1000

1 3 5 7 9 111315171921232527293133353739414345474951535557596163656769717375777981838587899193

Count

2009 200 400 600 800 1000

1 3 5 7 9 111315171921232527293133353739414345474951535557596163656769717375777981838587899193

2011

Age Number of Individuals

A new population of young HCV cases is emerging in Philadelphia 2007-2013

200 400 600 800 1000

1 3 5 7 9 1113151719212325272931333537394143454749515355575961636567697173757779818385878991

2013 Data provided by Dr. Kendra Viner PhD from the Philadelphia Department of Public Health

http://www.cdc.gov/vitalsigns/heroin/

Two epidemics intertwined

HCV infection is a serious health consequence of injection drug use

• HCV antibody prevalence among people who inject drugs is estimated to be 70

to 77%

• 1 of 3 people who inject drugs acquire HCV infection in their first year of

injecting

Syringe services and treatment for substance use disorder, essential parts of the response to the opioid epidemic, can also prevent transmission of HCV Part of the value of both opioid agonist therapy and SEPs is that they provide clients with an entry point to the health system

Nelson et al., 2011 Hagan et al., 2008 HHS, 2013 Volkow et al., 2014 MacNeil and Pauly, 2011

Harm reduction services are necessary

SEPs in the United States do not have sufficient coverage Evidence indicates that SEPs neither encourage new users nor increase drug use among clients Drug paraphernalia laws and regulations on the sale of syringes can impede the proper reach of syringe services

• Without such restrictions and with public funding, SEPs can distribute more

equipment and offer complementary services, including HCV testing

Des Jarlais et al., 2015 Burris et al., 2002 Bramson et al., 2015

Beyond Syringe Exchange

Although legally prohibited in the US, supervised injection facilities, clinics where people can inject under clinical supervision, may be another means

• f harm reduction

Supervised injection has been shown to reduce death from overdose

• Vancouver: 35% reduction in the rate of fatal overdose vs 9% reduction

in other parts of the city

Drug Policy Alliance, 2016. Marshall et al., 2011

Paul Yabor, 55 yo Coinfected with HIV and HCV Activist

February 22nd 2017, newsworks.org

May 19th, 2017 Philly.com

Treating two epidemics

Addiction is a chronic, relapsing disease of the brain Harm reduction, public health programs are needed

• Safe Injection Sites
• Syringe Exchange Programs
• Naloxone (Narcan) trainings and distribution
• Medication Assisted Treatment
• Suboxone
• Methadone
• Naltrexone (Vivitrol)

HCV testing, linkage to care, and treatment

• Elimination of treatment restrictions
• Test and treat model of care
• Integrated models of care